HomeMy WebLinkAbout6409 Garrison Ct - Applications/Water Heater - 12/03/2014DEC/03/2014/WED 02:56 PM DELTA MECHANICAL -AZ FAX No,480-898-0005
P. 002
Ci�t+y, of�"''� p C► Planning, Development & Transportation
281 N. (� F 4 Collins Fort Coll nsi , CO 80524 lege Ave P.O.
�x 580
Phone 970-416-2740 Fax 224-6134
OVER-THEnCOUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit p Lawn Sprinkler ❑ Mobile Home replacement ❑ Rooting ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 111 Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #_ 14.124AS Date
For otr" use only
lab Site Address (mqu/red) I , Value of Construction (labor, materials, profit)
_CeyO-1 [Tot>ri di Fed As11 4, O gmozz � la91• `1 1
Property Owner Name Address City/State Zip Phone
ClufMur
Ay ~ �q/ ��I
Applicant Name
Address City/State Zip Phone
rime dt� low - of b2
Contractor Address City/State Zip Phone
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? Ef Here ❑ Report
Sa/esraxn bya/icontradom Are you paying with your trust account? eYes ❑ No
Is this a residential or commercial project? 16 Residential CI Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar 1:1 Church ❑ Hotel/Motel ❑ Medical office ❑ Office CI Retail
❑ Restaurant ❑ Other (explalp)
Is this building SO years of age or more? M Yes WNQ ffyes, you may need to contact H/stonc,preserw on
If this Is for a demolition permit, what year was the building constructed?
!f prior to 1975, you will need an asbastos assessment to submit w/ttr thls app//ration.
*If lawn sprinkler/badcfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: /lst the cnmpanyname or 00, of Ft co///ns /icenm #
Electrician Plumber Mechanical Roofer
Other
I hereby acknowledge that I have read this application and state that the above information Is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit Is not valid until It has been paid and Issued.
Appll®nt:
Print Name: � Signature Date �2 ��